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What Is Angina Pectoris
Angina Pectoris
Learning Objective:
• Define Angina Pectoris
• Listnthe etiogy of angina pectoris
• State the type of angina pectoris
• List the clinical manisfestation for angina
• List the investigation
• Medication used to treat angina
• Nursing management for angina pectoris
• Health education given to angina patient
• Identify nursing problem for angina
• Nursing intervention for the identified problem
WHAT IS ANGINA PECTORIS
Definition:
• Referring to acute chest pain or discomfort resulting from decreased blood supply to the heart muscle (Myocardial Ischemia).
• Occurs due to imbalance between myocardial blood supply and demand
Etiology:
1. Physical exertion → increased oxygen demand → chest pain
2. Exposure to cold → vasoconstriction → increased blood pressure → increased oxygen demand → chest pain
3. Eating a heavy meal → increased blood flow to mesenteric area for digestion → reduced blood flow to heart muscle → chest pain
4. Stressful or emotional situation → release of adrenaline → increase blood pressure → increase cardiac workload → increase oxygen demand → chest pain
Type of Angina Pectoris
1. Stable Angina
• Most common and predictable angina
• The pain occurs with physical exertion ,sress, exposure to cold
• Relieved by rest and nitrates
2. Unstable Angina
• Brought on by minimal exertion as well as at rest
• Occurs more frequent ,more severe and last longer
• Not relieved with GTN promptly
3. Variant or Prinzmetal Angina
• Caused by coronary vasospam
• Unpredictable and occur often at night
4. Nocturnal Angina
• Occurs only during the night and associated with the REM (Rapid Eye Movement)
5. Angina Decubitus
• Occurs when the client reclines and lessens when the client sits or stands up.
6. Intractable Angina
• Is chronic incapacitating angina unresponsive to intervention
7. Post Infarction Angina
• Occurs after MI, when residual ischemia may cause episodes of angina
8. Silent Ischemic
• Objectives evidence of ischemia, but the patient reports no symptoms
Manifestation
• Cardinal sign – chest pain
• The pain can be described – tight ,squeenzing ,heavy pressure or constricting pain
• Begins at sternum and may radiate to jaw ,neck ,or arm
• Feeling of weakness and numbness in the arm ,wrists ,and hand accompany the pain
• Additional manisfestion – dyspnea ,pallor ,tachycardia ,diaphoresis ,dizziness ,lightheadedness ,nausea ,vomiting ,anxiety and fear
• Last less than 15 minute and relieved by rest ,position and nitrates
Investigation
• ECG (Electrocardiogram)
• Echocardiogram
• Stress Test
• Nuclear Scan
• Coronary Angiogram
• Cardiac Catheterization
• Blood Test – Lipid Profile ,glucose level ,cardiac enzyme
Medication
• Analgesic – to reduce or relieve acute pain e.g. Morphine
• Nitrates – vasodilators that reduce pain and prevent further attack by widening the arteries e.g. GTN
• Beta blockers – to reduce the workload of the heart e.g. Propranolol ,Atenolol
• CA channel blocker – to dilate the coronary arteries e.g. Diltiazem ,Nifedipine
• Anti – platelet e.g. Aspirin ,clopidogrel (Plavix)
Management
• Assessment of patient – general condition ,severity of pain ,location of pain
• Vital sign (B/P, Pulse rate, Tempreture, Spo2)
• Obtain ECG reading
• Medication – GTN and Morphine
• Oxygen (O2) therapy – to ensure adequate oxygenation
Health Education
• Educate the client to avoid activities or habit that precipitate angina attack
• Medication – on how to take anti – angina medication (e.g. GTN)
• Management of hypertension – control with medication
• Reduce weigth for obese client
• Stop smoking
• Adjust to avoid stressful activity
GLYCERIN TRINITRATES (GTN)
• Is a vasodilators
• Help to reduce acute pain and prevent further attacks by widening the diameter of coronary arteries and increase the supply of O2 to the myocardium
• Can be given S/L (Sublingual) ,oral tablet or translingual spray
• Reduce angina pain within 1-2 min
• 3 pills can be taken at 5 minute interval
• Can be taken prior to heavy activity
• If not relieved ,to seek Doctors treatment
Nursing Problem
• Chest pain related to decreased blood supply to heart muscle
• Anxiety due to chest pain or knowledge deficit
• Difficulty I compliance to medication therapy and change of lifestyle
• Potential for deterioration in condition
Nursing management
1. Educate patient on chest pain – e.g. to report any chest pain. Take medication as prescribe before any activities.
2. If patient have any chest pain ,report to medical staff. Give S/L GTN as prescribed. Give oxygen therapy as ordered. Sit patient in cardiac or fowlers position to help the lung to expand.
3. Observations – take vitals until stable if patient is on beta blockers , calcium channel blockers or nitrates therapy , especially the first dose.
4. Health education – No smoking ,low cholesterol diet and low fat diet*, Encourage daily exercise* after discharge. Patient who is obese should be encourage to lose weight.
5. Emphasis on the important of follow – up appointment. Advise patient to go to hospital immediately. If pain not relieved by S/L GTN.
6. Observe for bruises and any signs of bleeding if patient is on aspirin.
7. Advise patient on the care of his GTN tablets. They must be kept in dark color bottle. Always carry the tablets with them wherever they go.
8. Reduce fear and anxiety.
9. Give mild laxative* PRN if necessary to avoid stress to the heart during defecation.
10. Encourage leg exercise to prevent deep vein thrombosis if patient is on bed rest.
Created By: SN.CaR
Learning Objective:
• Define Angina Pectoris
• Listnthe etiogy of angina pectoris
• State the type of angina pectoris
• List the clinical manisfestation for angina
• List the investigation
• Medication used to treat angina
• Nursing management for angina pectoris
• Health education given to angina patient
• Identify nursing problem for angina
• Nursing intervention for the identified problem
WHAT IS ANGINA PECTORIS
Definition:
• Referring to acute chest pain or discomfort resulting from decreased blood supply to the heart muscle (Myocardial Ischemia).
• Occurs due to imbalance between myocardial blood supply and demand
Etiology:
1. Physical exertion → increased oxygen demand → chest pain
2. Exposure to cold → vasoconstriction → increased blood pressure → increased oxygen demand → chest pain
3. Eating a heavy meal → increased blood flow to mesenteric area for digestion → reduced blood flow to heart muscle → chest pain
4. Stressful or emotional situation → release of adrenaline → increase blood pressure → increase cardiac workload → increase oxygen demand → chest pain
Type of Angina Pectoris
1. Stable Angina
• Most common and predictable angina
• The pain occurs with physical exertion ,sress, exposure to cold
• Relieved by rest and nitrates
2. Unstable Angina
• Brought on by minimal exertion as well as at rest
• Occurs more frequent ,more severe and last longer
• Not relieved with GTN promptly
3. Variant or Prinzmetal Angina
• Caused by coronary vasospam
• Unpredictable and occur often at night
4. Nocturnal Angina
• Occurs only during the night and associated with the REM (Rapid Eye Movement)
5. Angina Decubitus
• Occurs when the client reclines and lessens when the client sits or stands up.
6. Intractable Angina
• Is chronic incapacitating angina unresponsive to intervention
7. Post Infarction Angina
• Occurs after MI, when residual ischemia may cause episodes of angina
8. Silent Ischemic
• Objectives evidence of ischemia, but the patient reports no symptoms
Manifestation
• Cardinal sign – chest pain
• The pain can be described – tight ,squeenzing ,heavy pressure or constricting pain
• Begins at sternum and may radiate to jaw ,neck ,or arm
• Feeling of weakness and numbness in the arm ,wrists ,and hand accompany the pain
• Additional manisfestion – dyspnea ,pallor ,tachycardia ,diaphoresis ,dizziness ,lightheadedness ,nausea ,vomiting ,anxiety and fear
• Last less than 15 minute and relieved by rest ,position and nitrates
Investigation
• ECG (Electrocardiogram)
• Echocardiogram
• Stress Test
• Nuclear Scan
• Coronary Angiogram
• Cardiac Catheterization
• Blood Test – Lipid Profile ,glucose level ,cardiac enzyme
Medication
• Analgesic – to reduce or relieve acute pain e.g. Morphine
• Nitrates – vasodilators that reduce pain and prevent further attack by widening the arteries e.g. GTN
• Beta blockers – to reduce the workload of the heart e.g. Propranolol ,Atenolol
• CA channel blocker – to dilate the coronary arteries e.g. Diltiazem ,Nifedipine
• Anti – platelet e.g. Aspirin ,clopidogrel (Plavix)
Management
• Assessment of patient – general condition ,severity of pain ,location of pain
• Vital sign (B/P, Pulse rate, Tempreture, Spo2)
• Obtain ECG reading
• Medication – GTN and Morphine
• Oxygen (O2) therapy – to ensure adequate oxygenation
Health Education
• Educate the client to avoid activities or habit that precipitate angina attack
• Medication – on how to take anti – angina medication (e.g. GTN)
• Management of hypertension – control with medication
• Reduce weigth for obese client
• Stop smoking
• Adjust to avoid stressful activity
GLYCERIN TRINITRATES (GTN)
• Is a vasodilators
• Help to reduce acute pain and prevent further attacks by widening the diameter of coronary arteries and increase the supply of O2 to the myocardium
• Can be given S/L (Sublingual) ,oral tablet or translingual spray
• Reduce angina pain within 1-2 min
• 3 pills can be taken at 5 minute interval
• Can be taken prior to heavy activity
• If not relieved ,to seek Doctors treatment
Nursing Problem
• Chest pain related to decreased blood supply to heart muscle
• Anxiety due to chest pain or knowledge deficit
• Difficulty I compliance to medication therapy and change of lifestyle
• Potential for deterioration in condition
Nursing management
1. Educate patient on chest pain – e.g. to report any chest pain. Take medication as prescribe before any activities.
2. If patient have any chest pain ,report to medical staff. Give S/L GTN as prescribed. Give oxygen therapy as ordered. Sit patient in cardiac or fowlers position to help the lung to expand.
3. Observations – take vitals until stable if patient is on beta blockers , calcium channel blockers or nitrates therapy , especially the first dose.
4. Health education – No smoking ,low cholesterol diet and low fat diet*, Encourage daily exercise* after discharge. Patient who is obese should be encourage to lose weight.
5. Emphasis on the important of follow – up appointment. Advise patient to go to hospital immediately. If pain not relieved by S/L GTN.
6. Observe for bruises and any signs of bleeding if patient is on aspirin.
7. Advise patient on the care of his GTN tablets. They must be kept in dark color bottle. Always carry the tablets with them wherever they go.
8. Reduce fear and anxiety.
9. Give mild laxative* PRN if necessary to avoid stress to the heart during defecation.
10. Encourage leg exercise to prevent deep vein thrombosis if patient is on bed rest.
Created By: SN.CaR
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